The Comparative Study Of Right Anterolateral Minithoracotomy And Median Sternotomy In The Mitral Valve Replacement

Objective:Right anterolateral minithoracotomy and median sternotomy are commonly used means of heart valve surgery. The former, as the traditional method, has become the standard operation. And the latter was a new method of treatment which was developed in the last ten years. Currently its safety and efficacy of the treatment is still controversial. Through a retrospective case-control method,this study compared the effect and complications of the45cases of right anterolateral minithoracotomy and22cases of median stemotomy in mitral valve replacement, and evaluated objectively the efficacy and safty.Methods:Clinical datas from45patients (minimally invasive group) received right anterolateral mini-thoracotomy from December2009to May2011, and22patients (traditional group) underwent median sternotomy from January2009to December2009were analyzed retrospectively. The preoperative datas (age, gender, and cardiac function classification)、Perioperative and postoperative datas(operation time, CPB time, aortic clamp time, postoperative mechanical ventilation time, postoperative hospitalization time, length of ICU stay, postoperative chest drainage, blood transfusion, hospital expenses, etc)、complications (Lung infection, wound infection, re-exploration of bleeding, arrhythmia, etc.) and follow-up results (heart structure and function, the long-term outcome and complications, etc.) were compared between the two groups. The count data and measurement data were statistical analyzed with chi-square test and T test by using SPSS17.0software.P less than0.05was considered statistically significant.Results:There were not significant differences in the comparison of the preoperative datas (P>0.05). Minimally invasive group had no death,but traditional group had2death cases. There were no significant differences in re-exploration for bleeding rate, new onset atrial fibrillation, pneumonia, cerebrovascular accident, septic wound of complications, phrenic nerve injury (P>0.05). The minimally invasive group were longer than the traditional group in the times of extracorporeal circulation and aortic clamp (P<0.05). But ICU stay、postoperative mechanical ventilation time、postoperative hospitalization time in the minimally invasive group were shorter than in the traditional group (P<0.05). The traditional group had more blood loss and needed more blood transfusion than the minimally invasive group (P<0.05). Postoperative follow-up results:The mean follow-up time of minimally invasive group was12.0±4.5months, and the traditional group was26.3±3.4months. There were not death casaes and people who had peri valvular leakage、cerebrovascular accident、mechanical valve failure、 hemolytic or infective endocarditis on the both groups. Minimally invasive group had5cases of anticoagulation excessive, and4cases of tricuspid insufficiency, while2cases of anticoagulation excessive, and2cases of tricuspid insufficiency were found in the traditional group. There were not significant differences between the two groups (P>0.05). The differences in the cardiac function classification between minimally invasive group and traditional group were not significant (P>0.05).Conclusion:The right anterolateral mini-thoracotomy in the mitral valve replacement is safe and effective. It can be performed with good cosmetic and clinic effectiveness. The surgeon should strictly control operation indications, choice cases, abide by the treatment principle and operation norm, take indiidual therapeutic methods in the minimally invasive surgery.